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Prophylactic jejunostomy: a reappraisal

J L Zapas¹, S Karakozis, J R Kirkpatrick

¹Department of Surgery, Washington Hospital Center, Washington, DC 20010, USA.

|October 22, 1998

Summary

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Prophylactic jejunostomy, intended for postoperative nutrition, shows a low benefit-risk ratio. This study suggests abandoning this procedure in favor of alternative nutritional support methods.

Area of Science:

Surgical Nutrition
Gastrointestinal Surgery

Background:

Enteral feeding is effective for postoperative nutrition.
Prophylactic jejunostomy is recommended during high-risk abdominal operations.
Procedure failure carries risks without clear benefits.

Purpose of the Study:

To compare the benefit/risk of prophylactic jejunostomy versus therapeutic jejunostomy.
To analyze complication rates, parenteral nutrition avoidance, and feeding discontinuation.

Main Methods:

Retrospective analysis of 92 patients (1993-1996).
Group A: Prophylactic jejunostomy; Group B: Therapeutic jejunostomy.
Classification based on surgeon's preoperative intent.

Main Results:

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Parenteral nutrition was not avoided in 39% of patients.
Group A had a 5-fold increased risk of feeding discontinuation (P < .03).
Complication rates were higher in Group A (41%) vs. Group B (26%), with 4 life-threatening events.

Conclusions:

The benefit-risk ratio for prophylactic jejunostomy is low.
The procedure is associated with increased complications and feeding issues.
Alternative nutritional support methods should be considered over prophylactic jejunostomy.